Asked by Seymore Applebaum, Toronto, Ontario
Is it necessary to have a colonoscopy when you're over age 50?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Colon cancer is one of the top three most common causes of cancer death in the U.S., Canada, and Europe.
There is very high certainty from well-designed trials that colon cancer screening, combined with effective follow-up and treatment of abnormal findings, reduces risk of colon cancer death by at least 35 percent and risk of getting colon cancer by 20 percent. I cannot overstress urging all normal-risk persons age 50 and above to start some kind of routine colon cancer screening. Next to lung cancer, it is the most preventable cause of cancer death.
Virtually every organization that has issued screening recommendations recommends that a normal-risk person (someone without a family history of colon cancer) start colorectal screening at the age of 50. The best data support use of a high-sensitivity stool blood test administered every year. Those with an abnormal finding should get colonoscopy to assess the colon for polyps, diverticula and cancer.
The next best data come from studies showing the benefits of sigmoidoscopy (fiber-optic visual assessment of the left side of the colon) every five years combined with stool blood testing. Many experts believe that colonoscopy (fiber-optic examination of the entire colon) every 10 years is beneficial. Colonoscopy requires an inconvenient bowel prep to remove all stool.
Recently, a number of groups, including my employer, the American Cancer Society, have also recommended considering virtual colonoscopy, which involves the same bowel preparation and a CT scan with some radiation exposure. Studies suggest that virtual colonoscopy with a CT scanner may actually be better than colonoscopy in finding colon cancer. The physician has a rewind button and can review the colon more than once. This is something not possible with colonoscopy.
I often tell patients, I do not care what test you choose, I just care that you choose and get a test. All persons with abnormal findings will ultimately need a colonoscopy.
Persons with a family history of colon cancer at an early age, or a history of inflammatory bowel disease such as ulcerative colitis, may benefit from screening at an earlier age and may be best served with colonoscopy rather than the other screening techniques.
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